Gene therapy for head and neck cancer

Combined effect of the pro-apoptotic rhTRAIL protein and HSV-1 virus in head and neck cancer cell lines

Knowledge on the molecular and clinical characteristics of head and neck squamous cell carcinoma (HNSCC) is vast. However, an effective therapy that increases the life expectancy of these patients, with a 5-year overall survival of 50%, is still unknown. Here we evaluated the combined effect of the pro-apoptotic protein rhTRAIL with the replication-competent wild-type HSV-1 virus in head and neck cancer cell lines. We observed a difference in the modulation profile of proteins related to apoptotic pathways in the studied cell lines. The HCB289 exhibited caspase-9 activation in the presence of the HSV-1 virus, while the UD-SCC-2 exhibited caspase-8 activation in the presence of rhTRAIL. Both cell lines exhibited PARP activation by combining rhTRAIL and HSV-1 virus treatment. Flow cytometry analysis exhibited greater induction of late apoptosis for the HCB289 and UD-SCC-2 after the combination treatment of the HSV-1 and rhTRAIL. However, the UD-SCC-2 also presented induction of late apoptosis by the presence of rhTRAIL in monotherapy. These data suggest an enhancement of the effect of the combination treatment of the rhTRAIL and the HSV-1 on reducing viability and induction of cell death.

Expression and correlation of NRF2, KEAP1, NQO-1 and HO-1 in advanced squamous cell carcinoma of the larynx and their association with clinicopathologic features

The present study aimed specifically investigate the expression and correlation of kelch-like ECH-associated protein-1 (KEAP1), nuclear factor (erythroid-derived 2)-like 2 (NRF2), quinone oxidoreductase-1 (NQO-1) and heme oxygenase-1 (HO-1) in laryngeal cancer and their association with clinicopathological features. A total of 33 paired human fresh advanced laryngeal cancer and adjacent normal specimens were collected following total laryngectomy. Immunohistochemical and immunoblotting analysis were performed to evaluate the expression of KEAP1, NRF2, NQO-1 and HO-1. All of the patients clinicopathologic features were collected. Immunohistochemistry indicated that NRF2-positive staining was as high as 79% (26/33) in the cancer samples and predominantly located in the nuclei, whereas positive expression of KEAP1, NQO-1 and HO-1 was detected in 70% (23/33), 76% (25/33) and 82% (27/33) of cancer tissues, respectively, and primarily expressed in the cytoplasm. The corresponding adjacent normal samples produced almost no or weak expression of the proteins. There were significant differences in protein expression between the two groups (P<0.01). Immunoblotting analysis also demonstrated that their expression levels were higher in cancer tissue compared with adjacent normal tissue. Notably, KEAP1, NQO-1 and HO-1 expression was positively correlated with nuclear NRF2 in cancer tissues, whereas they had no correlation with age, tumor stage (clinical stage III and IV), tumor size and lymph node metastasis. In conclusion, increased expression of NRF2, KEAP1, NQO-1 and HO-1 were common in advanced laryngeal cancer. Evaluation of these factors may have important clinical significance for the diagnosis and treatment of this disease.

Viral gene therapy for head and neck cancer

BACKGROUND

Viral gene therapy is a promising new treatment modality for head and neck cancer. This paper provides the reader with a review of the relevant literature in this field.

RESULTS

There are government licensed viral gene therapy products currently in use for head and neck cancer, utilised in conjunction with established treatment modalities. The viruses target tumour-associated genes, with the first licensed virus replacing p53 gene function, which is frequently lost in tumourigenesis. Oncolytic viruses selectively destroy cancer cells through viral replication and can be armed with therapeutic transgenes.

CONCLUSION

Despite considerable advances in this field over the last 40 years, further research is needed to improve the overall efficacy of the viruses and allow their widespread utilisation in the management of head and neck cancer.

Lentiviral vector-based therapy in head and neck cancer (Review)

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common neoplasm worldwide. Despite advances in multimodality treatments involving surgery, radiation and chemotherapy, the five-year survival rate has remained at ~50% for the past 35 years. Therefore, the early detection of recurrent or persistent disease is extremely important. Replication-incompetent HIV-1-based lentiviral vectors have emerged as powerful and safe tools for gene delivery. Commonly, HNSCC is a locoregional disease that presents at or close to the body surface. Thus, HNSCC is amendable to intratumoral injections of gene therapy vectors aimed at correcting defects associated with tumor suppressor genes to induce the direct cytotoxicity of cancer cells or immune modulation to promote antitumor immunity. Current investigations analyzing HNSCC gene mutations and stem cell markers and the cancer immunoediting concept are creating exciting therapeutic opportunities for lentiviral and other gene transfer vectors. The present review reports specific examples of the current applications of lentiviral vectors in HNSCC.

New developments and opportunities in oral mucosal drug delivery for local and systemic disease

The oral mucosa's accessibility, excellent blood supply, by-pass of hepatic first-pass metabolism, rapid repair and permeability profile make it an attractive site for local and systemic drug delivery. Technological advances in mucoadhesives, sustained drug release, permeability enhancers and drug delivery vectors are increasing the efficient delivery of drugs to treat oral and systemic diseases. When treating oral diseases, these advances result in enhanced therapeutic efficacy, reduced drug wastage and the prospect of using biological agents such as genes, peptides and antibodies. These technologies are also increasing the repertoire of drugs that can be delivered across the oral mucosa to treat systemic diseases. Trans-mucosal delivery is now a favoured route for non-parenteral administration of emergency drugs and agents where a rapid onset of action is required. Furthermore, advances in drug delivery technology are bringing forward the likelihood of transmucosal systemic delivery of biological agents.

Lister vaccine strain of vaccinia virus armed with the endostatin-angiostatin fusion gene: an oncolytic virus superior to dl1520 (ONYX-015) for human head and neck cancer

Oncolytic viral therapy represents a promising strategy for the treatment of head and neck squamous cell carcinoma (HNSCC), with dl1520 (ONYX-015) the most widely used oncolytic adenovirus in clinical trials. This study aimed to determine the effectiveness of the Lister vaccine strain of vaccinia virus as well as a vaccinia virus armed with the endostatin-angiostatin fusion gene (VVhEA) as a novel therapy for HNSCC and to compare them with dl1520. The potency and replication of the Lister strain and VVhEA and the expression and function of the fusion protein were determined in human HNSCC cells in vitro and in vivo. Finally, the efficacy of VVhEA was compared with dl1520 in vivo in a human HNSCC model. The Lister vaccine strain of vaccinia virus was more effective than the adenovirus against all HNSCC cell lines tested in vitro. Although the potency of VVhEA was attenuated in vitro, the expression and function of the endostatin-angiostatin fusion protein was confirmed in HNSCC models both in vitro and in vivo. This novel vaccinia virus (VVhEA) demonstrated superior antitumor potency in vivo compared with both dl1520 and the control vaccinia virus. This study suggests that the Lister strain vaccinia virus armed with an endostatin-angiostatin fusion gene may be a potential therapeutic agent for HNSCC.

Advancing nonviral gene delivery: lipid- and surfactant-based nanoparticle design strategies

Gene therapy is a technique utilized to treat diseases caused by missing, defective or overexpressing genes. Although viral vectors transfect cells efficiently, risks associated with their use limit their clinical applications. Nonviral delivery systems are safer, easier to manufacture, more versatile and cost effective. However, their transfection efficiency lags behind that of viral vectors. Many groups have dedicated considerable effort to improve the efficiency of nonviral gene delivery systems and are investigating complexes composed of DNA and soft materials such as lipids, polymers, peptides, dendrimers and gemini surfactants. The bottom-up approach in the design of these nanoparticles combines components essential for high levels of transfection, biocompatibility and tissue-targeting ability. This article provides an overview of the strategies employed to improve in vitro and in vivo transfection, focusing on the use of cationic lipids and surfactants as building blocks for nonviral gene delivery systems.

A comparative review of the potential role of adenovirus and Herpes Simplex Virus in the treatment of advanced squamous cell carcinoma of the head and neck

The unsatisfactory outcome of patients who receive intensive multimodality treatment for advanced squamous cell carcinoma of the head and neck (SCCHN) has motivated investigators to seek novel treatments to improve survival. Advances in molecular biology has led to the development of cancer gene therapy (CGT) and revived interest in viral vectors as a mechanism. SCCHN is an ideal model for CGT as disease remains locoregional and is amenable to injection of viruses. Adenovirus and Herpes Simplex Virus Type-1 (HSV) are the most studied Oncolytic Viruses (OVs). Both viruses have been shown to select and replicate in tumour cells and demonstrate anti-tumour effect in laboratory studies and clinical trials. Toxicity from OVs is minor and manageable. Different adenoviral mutants have been investigated with mixed responses. One vector, H101, has now been licensed after showing significant tumour regression in conjunction with chemotherapy. HSV has a larger capacity to carry genetic material and with the addition of the granulocyte–macrophage colony–stimulating factor, has the potential to stimulate an immune response systemically and at the site of disease. OVs are limited by the distribution of virus beyond injection site and by pre-existing or rapidly established immune response. Phase III studies are required.

Targeted genetic and viral therapy for advanced head and neck cancers

Head and neck cancers usually present with advanced disease and novel therapies are urgently needed. Genetic therapy aims at restoring malfunctioned tumor suppressor gene(s) or introducing proapoptotic genes. Oncolytic virotherapeutics induce multiple cycles of cancer-specific virus replication, followed by oncolysis, virus spreading and infection of adjacent cancer cells. Oncolytic viruses can also be armed to express therapeutic transgene(s). Recent advances in preclinical and clinical studies are revealing the potential of both therapeutic classes for advanced head and neck cancers, including the approval of two products (Gendicine and H101) by a governmental agency. This review summarizes the available clinical data to date and discusses the challenges and future directions.

Ethics of cancer gene transfer clinical research

Cancer gene transfer is a relatively novel intervention strategy. In part because of this novelty, trials often present greater uncertainties than those investigating more conventional approaches. In the following review, I examine how this greater uncertainty might affect how clinical studies are designed, when they are initiated, their degree of risk, and whether such risk can be justified in terms of therapeutic benefit. The review also discusses two other ethical issues presented by gene transfer clinical research: fairness in subject selection and communications with the public. I conclude with a series of recommendations directed toward researchers, policymakers, and ethics committee members.

Gene therapy in head and neck cancer: a review

Gene therapy for cancer is a rapidly evolving field with head and neck squamous cell cancer being one of the more frequently targeted cancer types. The number of clinical trials in the UK is growing and there is already a commercially available agent in China. Various gene therapy strategies along with delivery mechanisms for targeting head and neck cancer are reviewed.

An in vitro model of radiation-induced craniofacial bone growth inhibition

Radiation-induced craniofacial bone growth inhibition is a consequence of therapeutic radiation in the survivors of pediatric head and neck cancer. Previously, the infant rabbit orbitozygomatic complex (OZC) was established as a reliable animal model. The purpose of this study was to develop a cell culture model from the rabbit OZC to study the effects of radiation in the craniofacial skeleton. Infant (7-week-old) New Zealand white rabbits were used in this study. Periostea from both OZC were harvested in sterile conditions, introduced into cell culture by way of sequential digestion, and subcultured at confluence. Cultures were analyzed for cellular proliferation (methylthiazoletetrazolium assay), alkaline phosphatase activity, collagen type I expression, and mineralization. Electron microscopy was performed to reveal the in vitro ultrastructure. Subsequently, rabbits were irradiated with sham or 15 Gy radiation, and cell cultures were developed and analyzed for cell numbers. Cell cultures, grown from OZC periostea, expressed osteoblast-like phenotype, with high alkaline phosphatase activity, collagen type 1 expression, and mineralization in an osteogenic environment. Electron microscopy confirmed the characteristic ultrastructural features of osteogenesis in vitro. Finally, significantly (P < 0.01) fewer cells were obtained from animals treated with 15 Gy radiation compared with those from control animals.A primary cell culture with osteoblast-like cellular phenotype was developed from infant rabbit OZC periosteum. This cell culture system responded to in vivo administered radiation by a significant decrease in cell numbers. This in vitro model will be subsequently used to study the cellular mechanisms of radiation and radioprotection in craniofacial osteoblast-like cells.

Current Options in Head and Neck Reconstruction

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Understand current trends in the treatment of head and neck cancer. 2. Discuss the challenges of reconstructing head and neck defects 3. Understand the different reconstructive options available for specific anatomical regions of the head and neck.

BACKGROUND

Reconstructive surgery of the head and neck is both technically challenging and rewarding. In the past 20 years, significant advances in this field have improved surgical outcomes and patient function. The development and subsequent refinement of microvascular techniques, in particular, have been a major reason for this progression.

METHODS

In this article, the authors review the current options available in head and neck reconstruction. Because a large number of major craniocervicofacial defects result from oncologic resection, the authors have focused their review on this particular subject. By dividing their discussion into different anatomical sites, the authors hope to cover all major aspects of this broad topic.

RESULTS

Free tissue transfer has revolutionized head and neck reconstruction. The most widely used free flaps include the fibula, radial forearm, anterolateral thigh, and rectus abdominis. Restoration of both form and function is the ultimate goal.

CONCLUSIONS

Although defects of the head and neck region present a challenge, successful cosmetic and functional results have been achieved with both local and free tissue flaps. The flexibility of free tissue transfer, however, has dominated this area and continues to be the method of choice for reconstruction of sizable defects.

Recent new approaches to the treatment of head and neck cancer

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer in the world and affects 50,000 Americans annually. During the past 20 years, treatments for HNSCC have changed dramatically due largely to the advent of novel approaches such as combined modality therapy, as well as improvements in surgical and radiotherapeutic techniques. Ongoing advances in the multidisciplinary management of this complex and multivariate disease process are resulting in improved function, quality of life and survival. Here, we review state-of-the-art therapy and presents selected advances in the treatment of head and neck cancer.

FasL gene therapy: a new therapeutic modality for head and neck cancer

In this study, we investigated the in vitro and in vivo efficacy of Fas ligand (FasL) gene therapy for the treatment of head and neck cancer. Three head and neck squamous cell carcinoma (HNSCC) cell lines (SCC-1, SCC-12, and SCC-14a) were treated with the Fas agonist CH-11, a monoclonal antibody to the Fas receptor, or with a replication-incompetent adenovirus (AdGFPFasL) expressing a modified murine Fas ligand gene fused to green fluorescent protein (GFP). A replication-incompetent adenovirus containing the GFP gene alone was used as a control for viral transduction toxicity (AdGFP). Cell death was quantified using a tetrazolium-based (MTS) assay. Cells were analyzed by flow cytometry to determine the expression of adenoviral and Fas receptors on the surface of the cells. Our results showed that the head and neck cancer cell lines are resistant to cell death induction when treated with the anti-Fas monoclonal antibody CH-11. This resistance can be overcome with AdGFPFasL, which was able to induce cell death in all three cell lines. Apoptosis induction was demonstrated using Western blotting by evaluating poly(ADP-ribose) polymerase, and caspase 9 cleavages. In addition, intratumoral injections of AdGFPFasL into SCC-14a xenografts induced significant growth suppression of tumors, indicating that FasL gene therapy may provide a new efficient therapeutic modality for HNSCC that is worthy of a clinical trial.